THE PRESS-CITIZEN, Iowa City, Iowa, Monday, July 28,
2003

Gannett News Service

CIRCUMCISION, RATES DECLINING

Once a widely accepted procedure among American
doctors, male circumcision has experienced a steady
decline in the last few decades.

Circumcision of newborns peaked in the United States
some 30 years ago at about 85 percent to 90 percent,
says Dr George Denniston, president of Doctors Opposing Circumcision, a
Seattle based-anti-circumcision organization with
members worldwide. These, days, those numbers are
around 55-60 percent, he says. The rates are even lower
In the western states of California, Oregon and
Washington, which have a combined rate of 35 percent,
Denniston adds. Some states also have stopped covering
circumcisions under Medicaid.

Denniston attributes the decline to increased
awareness among parents of what he considers a
dangerous, needless, procedure.

"It doesn't take anybody with an IQ over 70 to
realize that taking off half the skin of a normal penis
causes problems," Denniston says. "There's not a single
medical association in the entire world that approves
routine infant circumcision."

Others, however, point to studies showing the
benefits of circumcision. These include reduced risk
for urinary tract infections in babies and penile
cancer in older men, and potential benefits in
preventing HIV.

Then there are the religious and cultural reasons
behind the procedure.

"It's a ritual that celebrates the covenant into the
Jewish (religion)," says Rabbi Myra Soifer of Temple
Sinai in Reno, Nev. "Its central to the Jewish faith
because that's how Abraham came into the covenant as
the first Jew and agreed to the foundation and
theological commitment that is now Judaism."

MEDICAL MATTERS
No one can quite peg the origins of circumcision, which
dates back even further than Biblical accounts of
Abraham, according to the online Circumcision
Information and Resource Page.

"It's one of those things that have been done for a
long time and nobody even knows why it started,"
Denniston says.

In the, 1800s, circumcisions were encouraged by some
doctors in the United States as a way to prevent boys
from masturbating. These days, the touted benefits for
circumcision are more grounded in science than the
masturbation-induced madness and eternal damnation that
old proponents used to warn people about.

A common advantage mentioned is easier hygiene,
although this is more a convenience factor and not a
pressing need, says Dr. Catherine Wagoner, a
pediatrician. Proper
hygiene, or the lack thereof, might be considered
as an indication for circumcision in men who are either
too old or unable to properly clean underneath the
foreskin, since this can cause infections, Wagoner
says.

Circumcision also is used to treat phimosis, a
rare condition in which the foreskin is too tight to be
pulled back. In some cases, this condition can restrict
blood flow to the head of the penis.

Studies show that babies who are circumcised have a
significantly lower risk for urinary-tract infections
during their first year - about a one in 1,000 chance
as opposed to one in 100 for their uncircumcised
counterparts. Some studies also show increased
protection against genital warts and sexually transmitted
diseases such as gonorrhea and syphilis, and a
reduced risk of penile cancer in men and cervical
cancer in female partners.

One of the strongest findings for circumcision's
benefits appeared 'in the June 10, 2000, issue of the
British Medical Journal. The study found that
circumcised men are two to eight times less likely to
contract HIV through sex. Researchers said the likely
culprits were cells with HlV receptors found in the
inner surface of the foreskin. Although stopping short
of recommending routine male infant circumcision, the
researchers went on to suggest circumcision an
additional means of preventing infection, especially
those in central and southern Africa.

Hygiene, for one, shouldn't be a problem as long as
boys are taught how to clean underneath the foreskin
properly, Denniston says. Urinary tract infections also
should be treated just like any infection - with
medication, not by cutting off the foreskin, he added.
And as far as phimosis goes, even the worst cases
should be treatable by regularly stretching the
foreskin, he says. Denniston also dismisses the studies
about circumcisions medical benefits as inconclusive,
adding that a study has yet to come out with strong
enough findings to recommend routine routine infant
ciremcision.

For some, that is an argument that cuts both
ways.

If you look at the reseach there's no reason to do
it or not to do it," Wagoner says.

The American Academy of Pediatrics mirrors Wagoner's
view. in its circumcision policy released in 1999, the
AAP states that circumcision does have some potential
health benefits, although those benefits aren't
significant enough to recommend routine circumcision.
The AAP went on to say that the decision for
circumcision ultimately rests on parents, a neutral
stance that ultimately doesn't forbid or encourage the
procedure.

POLITICS COME INTO PLAY

For Denniston, the AAP response is largely
political.

"The AAP said the data is not sufficient to
recommend routine circumcision," Denniston says.
"Either data is sufficient or insufficient ... but they
go on to waffle because it's a 'CYA' operation - Cover
Your Ass. If they said it absolutely shouldn't be done,
then they open their members for lawsuits. They're
trying to ease their way out of this."

Cultural Decisions:

With the medical debate for circumcision raging to a
standoff, the driving force behind circumcision now
largely rests on two factors- culture and religion.

For anti-circumcision advocates, these could be the
biggest roadblocks of all.

In some cases, though, not being circumcised also
opens a boy to the same psychological trauma due to
ridicule from circumcised peers. This is especially
worse for boys in cultures that traditionally
circumcise their adolescents as a rite of passage to
manhood.

Soifer whose religion has been practicing
circumcision for thousands of years, also doesn't agree
with the way anti-circumcision proponents portray the
procedure as being highly dangerous.

"Some doctors raise issues of psychology and, of
course, none of us can ever really know what's going on
inside the head of a tiny baby," Soifer says. "I think
there are a lot of questions one can raise about
circumcision but I think the fact that it's medically
dangerous is not factually verifiable."

APPEARANCE A FACTOR
Some don't even need reasons of higher purpose, such as
culture and religion. For others, the preference for
circumcision boils down to good, old looks - not just
in the eyes of men but for female partners as well.

With many women, the preference doesn't stop there.
Even Denniston, who says that circumcised males feel
less sexual pleasure because of the removal of the
highly sensitive foreskin, admits that there is a
common view among women in the United States that sex
with a circumcised penis feels better.

"It's in the eye of the beholder," says Denniston,
adding that the perceived extra pleasure is likely
psychological.

With the medical debate at a standstill and the
strong influence of religion and culture, circumcision
in the United States will likely stay at the near 50-50
split it's been hovering at lately. For people like
Wagoner, that isn't exactly a bad thing.

"You can go through your whole life either
circumcised or uncircumcised and be completely fine,"
Wagoner said. "It still remains a parent's choice."